As North Carolinians navigate COVID-19 and its various impacts, NCOHC decided to sit down with our partner program at FHLI to discuss how the pandemic poses significant mental health concerns, for patients and providers alike.

Tyndall, a licensed marriage and family therapist, said that the wide range of impacts caused by COVID-19 — from financial stress to anxiety and isolation — are serious stressors that negatively impact mental health.

“The fact that we can’t be with each other absolutely negatively impacts the coping mechanisms most people use of reaching out and spending time with friends and loved ones,” said Tyndall. “We are wired to connect, and right now we are limited in those personal, face-to-face relationships.”

For the provider community specifically, Tyndall worries that we tend to forget that they are humans, too.

“I think that we forget that the frontline providers are facing a lot of the same uncertainty that the rest of us are,” said Tyndall. “Especially for those providers who live alone or are caregivers in their personal lives. If a provider doesn’t have a support system, or if their support system is already stretched thin, it is an especially difficult time. There’s a physical as well as an emotional toll to the stress, and it builds up. Providers manage the stress of patient caregiving every day, and then still go home to manage their own households, potentially adding an additional layer of stress.”

“As doctors, we are trained to be the rock,” said Dr. Zachary Brian, NCOHC’s director. “We’re trained to be the provider, there to serve the community, sometimes at the expense of our own physical and mental health.”

Both Tyndall and Brian described a juggling act for providers, balancing service to their communities, personal and family safety, as well as financial well-being.

“It can feel as though you are navigating a sea of conflicting resources, literature, and research to determine the safest way to move forward with your practice,” said Brian. “Given that this is a novel virus, it is not uncommon to see this type of response. The issue arises in that there’s no one clear authority to look to for guidance, which makes informed decisions on behalf of your patients and staff ever more challenging.”

As health experts learned more about the novel COVID-19 virus in recent months, guidance from the American Dental Association, the Centers for Disease Control and Prevention, and other state and national regulatory bodies were released, but were not always in exact agreement with one another.

“The resources for providers that we have seen, although very helpful, have not necessarily always been in parallel,” said Brian. “This has created a surge in confusion.”

What can you do about the uncertainty?

Dr. Brian says, “While the provider community as a whole may be very isolated during this time, forced to make decisions with so many unknowns, there is support within your regional communities. Don’t be afraid to reach out to your colleagues. People need to be very open and transparent, so we don’t have to navigate this crisis in a vacuum.”

Dr. Tyndall says, “We have to lift ourselves up and we have to lift each other up. We don’t have to talk about it all the time, but we also should give a voice to it and not minimize the stress. It is important to have outlets to express uncertainties, fears, and concerns.”

Dr. Tyndall also shared a couple of resources for providers who need help managing their own mental health needs during this time.

The Hope for NC Helpline is a free helpline for people who need assistance coping and maintaining resilience during COVID-19. The number for the 24-hour helpline is 855-587-3463.

For first responders, the University of Minnesota, the Minnesota Department of Health, and the University of Minnesota College of Education and Human Development have released a First Responder Toolkit to help those deployed in emergency response maintain their own physical, emotional, and social well-being. The app can be accessed here (note: a login is required).

Financial uncertainty is another stressor impacting many oral health care providers. This is especially salient in the private sector, where most dental practices are small businesses. On top of figuring out how to keep everyone safe and healthy, while still providing necessary care to the community, providers must also navigate out how to stay above water financially.

“Even though it seems like practices would be bustling during a health crisis, we also know that there is a side where providers aren’t seeing as many patients,” said Tyndall. “So that financial stress — especially for smaller practices, rural practices — is very real.”

Brian said that the oral health profession is on the low patient volume side of the equation. Largely due to the use of aerosolizing instruments, dentists, and hygienists in particular, are near the top of the list of most at-risk professions for COVID-19 transmission. In response to the elevated risk, most dental offices have only seen patients for urgent needs during the pandemic.

Brian said that in the oral health care space, safety net practices are facing profound and lasting financial impacts, as well. Practices that see patients regardless of their ability to pay, and who offer care on a sliding fee scale, have very thin to nonexistent margins to begin with. Nearly completely cutting off their revenue stream can be catastrophic.

What can you do to navigate financial uncertainty during COVID-19?

Dr. Brian points to the ADA’s resources for providers, especially the following the guidances:

Additionally, the North Carolina Division Health Benefits has issued temporary modifications for telehealth billing, and NCOHC has launched a teledentistry fund with support from the Blue Cross and Blue Shield of North Carolina Foundation.

If your practice is a safety net provider in need of teledentistry software, please reach out to ncohcinfo@foundationhli.org for information on how to apply for funding through the NCOHC Teledentistry Fund.

Please note: The aforementioned guidance documents are only to serve as a resource, and are not necessarily founded in scientific evidence, or endorsed by NCOHC.

According to Brian, it is important for providers to be aware of oral signs and symptoms that can alert them to potential mental health needs of their patients.

“You have parafunctional habits such as clenching and grinding that can develop as a result of stress, and from this you can see detrimental effects on teeth and other oral structures, such as extensive attrition and fractured teeth,” said Brian. “I saw that a lot with my patients when they were going through stressful events in their lives. They would come in with three or four fractures in their teeth, sometimes where the fractures extended past the gumline requiring surgical interventions.”

Brian also said that dietary changes due to stress and anxiety can negatively impact oral health. Increased sugary food and carbohydrate intake, as well as alcohol consumption, can both increase risk of tooth decay and gum disease.

“One thing that we’re not talking about enough is that we’re only seeing emergency patients right now,” said Brian. “There are people who are delaying appointments or not seeking care, and by the time they come in, what could have been a simple filling previously has now advanced to the point where it requires a root canal or an extraction. This is also particularly important for routine oral and pharyngeal cancer screenings.”

How can an oral health provider look out for mental health strains in patients?

“As an oral health professional, having a relationship with someone in the mental health space is vitally important, also. You need to have a sounding board to discuss mental health concerns of your patients, and a trusted referral source to help route that patient to proper care.”

“It is crucially important that you have deeper conversations with your patients. Make sure that you take a whole-person care approach by including the mental health of your patients into the patient experience.”

Both Tyndall and Brian agreed that taking time to reflect and take care of yourself is incredibly important for providers during this pandemic. Taking steps to interact with family, friends, and colleagues is an important way to cope with the isolation and stress we all are experiencing.

“Dig deep into your resource and faith buckets, and be kind to yourselves,” said Tyndall. “Take time to make sure that you’re taking care of yourself, too.”

“This too shall pass,” said Brian. “Dentistry remains a profession that allows us to impact our patients in direct ways, see immediate results, and change lives. That doesn’t change with the pandemic.”

This past November, the North Carolina Oral Health Collaborative welcomed two new staff members. Kelsey Ross Dew is NCOHC’s new program coordinator, and Brady Blackburn is the Collaborative’s content marketing specialist. As they pass the half-year mark, they sat down to answer a few questions about who they are and why they decided to join NCOHC.

Kelsey Ross Dew

Tell us a little about your background, where you are from, and your educational path.

I am from Severna Park, a town in Maryland situated right between Annapolis and Baltimore. Visiting family in North Carolina regularly, I became very familiar with the Wilmington area and was drawn to the university there.

I attended UNC-Wilmington, originally planning to go into nursing. I was exposed to so many fields and areas of study but just couldn’t choose. After looking at the courses closely, I decided on community health education for my undergraduate degree. That program at the time was transitioning to become the Public Health Program.

After graduating, East Carolina University offered a Master’s in Public Health program, so I decided to move from Wilmington to Greenville to pursue my MPH.

While working on my MPH, I worked as a research assistant for a childhood obesity prevention program. I was trained in research management, program management, evaluation and community engagement. I worked with that program for 2 years during my MPH and 2 years after graduating. Open to new opportunities at the time, I began to search for something different to focus on that would have a public health impact.

What professional accomplishment before coming to NCOHC are you most proud of?

I am most professionally proud of my master’s degree because it gave me time to build my skill set and learn.

What originally drew you to working in the oral health space?

I saw the job posting for the program coordinator for NCOHC and started thinking about working in the oral health space. It quickly made me realize that I had not been exposed to the importance of oral health and public health dentistry previously. I wanted to transition to something different that would benefit the health of the whole person. Oral health seemed like an area that needed strong advocates and I wanted to be a part of that.

What has been the most rewarding part of your work with NCOHC thus far?

The most rewarding part of my work so far has been the different opportunities to be involved in policy change and engage with community. Policy changes have a large impact on increasing access and are a sustainable solution. In addition, I really think working directly with community and engaging them in the policymaking process can be helpful. It is rewarding to work towards solutions.

What are the biggest challenges that you see facing access and equity in oral health care in North Carolina?

I feel that there are systemic barriers to change through restrictive policy that limit access and equity in oral health care in this state. There are numerous policy solutions available that are evidence-based and would increase access and address oral health among the most vulnerable populations.

What do you enjoy doing when not working?

I enjoy spending time with my husband and dogs, whether that be at home or out around Raleigh. We enjoy games, sports, and traveling (when safe!). I like cooking as well!

What do you want our membership to know about you?

I want our membership to know that I am so grateful to be a part of this work and team. It takes a lot of committed individuals to make lasting changes. I also think prevention is key and we should focus efforts on increasing preventative solutions.

Brady Blackburn

Tell us a little about your background, where you are from, and your educational path.

I have lived in North Carolina for my entire life. I grew up in Asheville and went to college at UNC-Chapel Hill, where I was in the second graduating class of a dual-degree program that paired an undergraduate degree in environmental studies with a graduate degree in mass communication.

I worked in climate change communication for The Nature Conservancy during graduate school before moving back to Western North Carolina to run a 2018 state legislative campaign in Haywood, Jackson, and Swain Counties. We won the campaign, and I joined Joe Sam Queen as his legislative assistant for the first half of the 2019-2020 legislative session.

I have always been drawn to the nonprofit world, so after a while in the legislature, I began to turn my eyes toward new opportunities.

What professional accomplishment before coming to NCOHC are you most proud of?

Managing Joe Sam Queen’s legislative campaign was one of the more difficult things I have done. I am incredibly proud of our victory. In the seven-month stint between my graduation and the 2018 election, I grew in ways that I didn’t know were possible and I learned a lot from my first-hand experience with Representative Queen’s constituents in Haywood, Jackson, and Swain Counties.

What originally drew you to working in the oral health space?

In high school, I found myself on the wrong end of a golf club and lost my two front teeth. I would say that’s when I first became passionate about oral health care, and when I first understood how expensive more serious procedures can be.

Years later, in the North Carolina Legislature, our top priority was expanding access to affordable health care for underserved North Carolinians. I didn’t have a lot of experience in health and health policy going in, but I quickly learned just how stark the disparities our state are, and how vital policy is when it comes to increasing equity and access.

What has been the most rewarding part of your work with NCOHC thus far?

I’ve had several opportunities to interview people across North Carolina who work in oral health care or who have been impacted by a lack of access to that care. Hearing their stories has been incredibly moving, and it has really helped me understand the importance of the work we do.

What are the biggest challenges that you see facing access and equity in oral health care in North Carolina?

I think that there is a world in which oral health care is affordable for everyone. Preventive care is so much less expensive than restorative care, but unfortunately so many don’t have access or don’t know where to go before costly treatment is necessary. Creating an education infrastructure and building a system where care is accessible, no matter who you are or where in the state you live, seems to me to be the biggest step we could take towards achieving oral health care equity.

What do you enjoy doing when not working?

When I’m outside the office I love gardening, woodworking, and taking my dog on adventures. We love to go backpacking or just generally get outdoors.

What do you want our membership to know about you?

I want the membership to know that my (virtual) door is always open! I think that collaboration and storytelling are key to good communication, and there are so many amazing stories to tell about the people working hard to improve North Carolinians’ oral health.

Oral Health Day 2020 is going digital! At NCOHC’s Oral Health Day Webinar on April 29, we announced plans to shift our signature advocacy event to an online format to ensure participant safety given COVID-19. Oral Health Day will now be a two-part event, and we’re bringing part two out of Raleigh and into communities across the state.

The theme for Oral Health Day 2020 will still be teledentistry, with a special focus on its use as a tool to mitigate access gaps in North Carolina. Our main event will still occur on June 3rd.

Part One: Virtual Oral Health Day

Instead of meeting in person, we will convene virtually to learn about teledentistry and its role in equitable oral health care. Speakers will discuss the state of oral health in North Carolina and the shortage areas we must address. They will also demystify teledentistry and describe how it can be used as a tool to bridge our state’s access gaps. Finally, our director will outline policy priorities to increase providers’ ability to incorporate teledentistry into their practices.

Virtual Oral Health Day Featured Speakers

Dr. Bill Donigan, Kintegra Health

Dr. Shaun Matthews, UNC Adams School of Dentistry

Dr. Andres Flores, ECU School of Dental Medicine

Darlene Leysath, The Cornerstone CDC

Bobby White, North Carolina Board of Dental Examiners

TBD, North Carolina Dental Society

TBD, North Carolina Legislature

Part Two: Community Tours

Since we will not be able to visit legislators at the North Carolina General Assembly this year, we have adapted our plan to include community tours of safety net dental clinics later this fall.

We will bring legislators and community members together for tours of Kintegra Health in the west, Green County Health Care in the east, and Piedmont Health in central North Carolina. Each visit will include a tour of the dental clinic, a teledentistry demonstration, and a town hall-style discussion with policymakers.